“The worst offender”: what is the environmental impact of surgery in hospitals?

This is an opinion piece co-authored by two surgeons. Victoria Pegna is Registrar of Colorectal and General Surgery at Sussex University Hospital and co-founder of the Sustainability in Surgery Committee. Vittoria Bellato is a clinical researcher at the Institut Universitaire de Saint-Marc and a member of the European Society of Coloproctology. Here they give us their take on the lack of sustainability in hospitals and what we should be doing about it.

Since the 1980s, surgeons have witnessed a rapid transformation of the tools available to us. As a colleague put it, “During my career we have gone from using only reusable devices to today where almost everything we use is single use.

This is not the norm all over the world – there is much less waste when resources are poor.

But in developing countries of Europe and North America, new processes have been introduced to simplify surgical procedures that claim to eliminate the risk of infection, such as thorough hand washing, the use of hand tools. single use individually wrapped and anesthetic gases.

However, there is a lack of recent evidence that single-use items are better than reusable sterile equipment. These new methods have been adopted by both the medical community and the public because only the health and results of the patient have been considered.

What about the health of the planet?

These practices have a devastating impact on the environment. In fact, a recent Lancet report estimated that the healthcare sector accounts for nearly 5% of all global carbon emissions, and the operating room is the worst offender.

How to improve the durability of the surgery?

This is not to say that there are no opportunities to improve the sustainability of our surgical practice. Water consumption can be significantly reduced with the use of alcohol-based hand gel (instead of rubbing) without increasing the risk to patients, but policies and surgeons have yet to adapt.

Sterilization and repair of reusable surgical tools – as opposed to eliminating single-use versions – not only reduces the environmental impact of an operation, but also saves healthcare services money long-term. This is because the larger cost of disposing, transporting and incinerating medical waste is often not even factored into the same procurement budgets.

An urgent challenge is the lack of awareness, even among surgeons and health workers.

Doctors have the power to vote with their feet and make small changes in the operating room and beyond. However, global research by the European Society of Coloproctology (ESCP) found that while around half of surgeons are keen to make changes, such as forgoing non-sterile gloves and reducing the use of anesthetic gases during surgery , most surgeons (57 percent) were not even aware of the magnitude of the carbon footprint of surgical practice.

Three-quarters had never received advice on making their surgical practice more sustainable from their employer or nationally. Unfortunately, there is little research to allow for a change in the narrative.

8 out of 10 surgeons agree that surgical guidelines are urgently needed, but the evidence base is currently limited and therefore guidelines have yet to be developed. Some institutions, including ESCP and the specialist from the Center for Sustainable Healthcare in the UK, are making progress in carrying out the necessary research.

However, we still need many more experts from different specialties to drive more sustainable and innovative approaches in the field.

Why change must come from above

In the meantime, system-wide changes are long overdue and must come from above. Surgeons themselves must play a role, but hospital leadership has the greatest potential to create lasting impact.

Ethical purchasing must be a priority in the future; healthcare leaders can drive this change by signing contracts with companies that have good ethical and sustainability principles, and that source materials locally.

They can also make decisions about purchasing single-use or reusable instruments, keeping energy consumption to a minimum, and changing hospital policies to reflect the latest research and practices in patient safety and sustainability. At the same time, governments also have a responsibility to promote, facilitate and fund such efforts.

We rarely hear about the environmental burden of surgery in the media, as the finger is typically pointed at big business. Surgeons and hospitals also buy from manufacturers, and unfortunately, it is not in the financial interest of these companies to make reusable medical equipment like laparoscopic ports.

However, companies can make a difference by funding research into reusable products, minimizing packaging, reducing the use of resource-intensive materials, introducing biodegradable packaging and innovating new, more sustainable solutions.

Importantly, by taking these steps, they can also make the tools more affordable for surgeons working in low income countries.

Some might argue that the health of the patient should be our only priority, but in the long run, global warming will have serious consequences for human health, with the World Health Organization estimating an additional 250,000 deaths per year throughout. 2030-2050.

The UK’s National Health Service (NHS) goal of going net zero by 2040 is admirable but looks like a distant reality. As we seek to rebuild and strengthen our health systems in the recovery from COVID-19, we have a unique opportunity to establish more sustainable health services.

To protect the lives of our patients, the healthcare industry must make change now – 20 years from now is too late.


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